CareTrack Australia: assessing the appropriateness of adult healthcare: protocol for a retrospective medical record review

Abstract

IntroductionIn recent years in keeping with international best practice, clinical guidelines for common conditions have been developed, endorsed and disseminated by peak national and professional bodies. Yet evidence suggests that there remain considerable gaps between the care that is regarded as appropriate by such guidelines and the care received by patients. With an ageing population and increasing treatment options and expectations, healthcare is likely to become unaffordable unless more appropriate care is provided. This paper describes a study protocol that seeks to determine the percentage of healthcare encounters in which patients receive appropriate care for 22 common clinical conditions and the reasons why variations exist from the perspectives of both patients and providers.Methods/designA random stratified sample of at least 1000 eligible participants will be recruited from a representative cross section of the adult Australian population. Participants' medical records from the years 2009 and 2010 will be audited to assess the appropriateness of the care received for 22 common clinical conditions by determining the percentage of healthcare encounters at which the care provided was concordant with a set of 522 indicators of care, developed for these conditions by a panel of 43 disease experts. The knowledge, attitudes and beliefs of participants and healthcare providers will be examined through interviews and questionnaires to understand the factors influencing variations in care.Ethics and disseminationPrimary ethics approvals were sought and obtained from the Hunter New England Local Health Network. The authors will submit the results of the study to a relevant journal as well as undertaking oral presentations to researchers, clinicians and policymakers.

Surgical Site Infection—A Population-Based Study in Australian Adults Measuring the Compliance with and Correct Timing of Appropriate Antibiotic Prophylaxis

“…A sample designed to be representative of the adult Australian population was randomly selected from a phone directory (the Telstra White Pages) from defined regions within South Australia and New South Wales 12,13 . One adult was randomly selected from each household and recruited via the telephone.…”

“…A training manual provided inclusion and exclusion criteria and instructions for scoring indicators. Estimates for compliance were measured as the percentage of eligible encounters 12 for the SSI indicators that were answered 'yes'. The inclusion criteria for the indicators were specific to particular types of surgery (e.g.…”

“…There is an urgent need to move towards being able to monitor the appropriateness of care ("care in line with evidence-or consensus-based guidelines") 11,12 . The CareTrack Australia (CTA) study, undertaken by a number of the authors, was designed to establish baseline estimates of the appropriateness of care delivered, at a population level, by a full range of practitioners in real-world settings, and to determine what would be needed to monitor the ongoing appropriateness of care 12 . Prior to the publication of the CTA study, no comprehensive population study had been undertaken that measured the appropriateness of healthcare received by Australians for 22 common conditions.…”

CareTrack: assessing the appropriateness of health care delivery in Australia

“…A seminal study in the United States showed that American adults received “recommended care” only 55% of the time in the years 1999–2000 1 . Estimates of “appropriate care” — defined here as care in line with evidence‐based or consensus‐based guidelines 2 — are limited in most countries, including Australia, to small groups of conditions, often in particular settings 3 , 4…”

Development of evidence-based Australian medication-related indicators of potentially preventable hospitalisations: a modified RAND appropriateness method

“…In addition, our method for developing the indicators systematically combined the available evidence base with the opinion of clinical experts to develop indicators that are both face and content valid 19. The modified RAND method used in our study has been used in indicator development studies previously 18 45. A recent Australian study used this method to validate 657 indicators of healthcare appropriateness 16…”